Universal Precautions and Bloodborne Pathogens

*This program has been adapted with permission of the Greater Los Angeles Veterans Administration Medical Center*

Universal Precautions and Bloodborne Pathogens

  • Objectives
  • IC Manuals
  • Hand Hygiene
  • Bloodborne Pathogens
  • Standard Precautions
  • TB Control Program
  • Transmission Based Precautions
  • Employee/Occupational Health

Infection Control

The Infection Control Program Goal is to protect patients, employees, volunteers and visitors from healthcare associated infections.

Objectives

  • Identify Infection Control Program Resources
  • Outline the Bloodborne Pathogens Exposure Control Plan
  • Describe the TB Control Program
  • List 3 things every employee can do to take care of his/her work area
  • Identify the single most important infection control measure

Infection Control Manuals

The Infection Control (IC) Manual is the primary reference for IC Policies and Standards. Manuals are available on the Internet.

Hand Hygiene

In 2004, the JCAHO national patient safety goals became effective. Goal 7 to reduce the risk of health care associated infections has been retained for 2005. It requires compliance with the CDC recommendations for hand hygiene. The Healthcare Agencies Directive on Required Hand Hygiene Practices provides guidance for healthcare facilities.

Healthcare Agencies Directive on Required Hand Hygiene Practices

Hand Hygiene is the single most important infection control measure!

All health care workers in direct patient contact areas, i.e., inpatient rooms, outpatient clinics, radiology, phlebotomy, and so forth must:

  1. Use an alcohol-based hand sanitizer OR antibacterial soap and water to routinely disinfect hands before and after having direct patient contact.
  2. If hands are NOT visibly dirty, use an alcohol-based hand sanitizer to routinely disinfect hands.
  3. When hands are visibly dirty do the following:
  • Wash hands with antibacterial soap and water OR
  • Wash hands with regular soap and water and then use an alcohol-based hand sanitizer.

Perform Hand Hygiene

  • Before patient contact
  • After patient contact
  • Before performing clean and aseptic procedures
  • After removal of gloves
  • Whenever hands are contaminated
  • Before donning sterile gloves
  • Before eating
  • After Toileting

Hand Hygiene Techniques

Handwashing

Use soap and water to wash hands. If you are using Antibacterial soap, hands are decontaminated. If using Regular soap, after drying, apply alcohol-based sanitizer to disinfect hand.

  • Rub all hand surfaces for 10-15 seconds.
  • Dry well with paper towels.
  • Use paper towel to turn off the faucet.

Hand Hygiene using alcohol-based sanitizer

  • Apply alcohol-based gel or foam to hands
  • Rub all hands surfaces together until dry

All health care workers who provide direct, hands-on care to patients may NOT wear artificial fingernails, nail wraps, or extenders; this includes non-supervisory and supervisory personnel who regularly or occasionally provide direct, hands-on care to patients.

Bloodborne Pathogens

Pathogens are germs that can cause disease Bloodborne pathogens are viruses such as Hepatitis B or C and HIV that can potentially be spread to others through exchange of body fluids. This can include:

  • Blood
  • Semen
  • Vaginal secretions
  • Urine
  • Non-fixed (hardened and preserved) tissues and other body fluids

Potential Routes of Exposure

  • Sticking yourself with a dirty needle
  • Punctures or cuts from dirty sharps or blades
  • Direct contact of infected blood or body fluids with broken skin
  • Touching dirty surfaces (like furniture, faucets and equipment)
  • Splashing infected fluids in your eyes, nose, and mouth.

Activities Posing Risk to Healthcare Workers

Patient care activities pose a risk to healthcare workers, such as:
  • Starting IV lines
  • Giving injections
  • Collecting blood specimens
  • Doing anything that cuts through the skin
  • Suturing
  • Suctioning

Other care activities also pose a risk, such as:

  • Handling dirty linens
  • Emptying sharps containers
  • Handling biohazardous waste
  • Processing/handling laboratory specimens
  • Environmental cleaning
  • Repairing patient care equipment

Symptoms of New Infection

Viral bloodborne pathogen infections usually present with symptoms similar to the flu:

  • Fever
  • Headache
  • Body ache
  • Fatigue
  • GI Upset

New onset of symptoms after an exposure could be an indication of newly acquired infection

Standard Precautions (Previously Known as Universal Precautions)

There is a potential for all blood and body fluids to transmit viruses Therefore:

  • All patients must be treated as if they are infectious.
  • Use standard precautions in providing for all patients.

Personal Protective Equipment (PPE)

All PPE (gowns, gloves, masks, shoe covers) must be removed immediately before leaving the patient treatment area, including:

  • Operating Room
  • Cardiac Cath Lab, GI, EP labs
  • Isolation rooms
  • Laboratory

One-way valve masks should always be used for CPR

If it’s warm, wet and not yours, wear gloves and use other appropriate PPE

Eating and Drinking

OSHA prohibits healthcare workers (HCW) from eating and drinking in patient care areas or any area where blood or body fluids are handled. This includes exam, treatment, procedure, and patient rooms, labs, EMS areas and nursing stations.

Follow the label on the door to identify room function!

Waste Management

According to the California State Medical Waste Management Program, the following items are treated as biohazardous waste:

  • Suction canisters
  • Laboratory and Operating Room waste
  • Sharps
  • Items containing visible liquid blood
  • Un-drained urine drainage bags
  • Specimens including non-fixed tissues

All biohazardous containers must have:

  • A red bag liner
  • An attached lid
  • Be appropriately labeled
  • Be foot operated if outside of a designated biohazard waste storage area

Blood/Body Fluid Spill Management

  • Cover small spills with a paper towel
  • Use Isolyser 13,000 to solidify spills
  • Spray with an approved germicide
  • Use gloved hands to clean up the spill
  • Small spills may be sprayed with a germicide and wiped off with paper towels

Tuberculosis Control Program

Control Plan - Signs and Symptoms

Patients with TB often present with common symptoms including:

  • Fever
  • Cough (lasting more than 2-3 weeks)
  • Night sweats
  • Unexplained weight loss
  • Loss of appetite
  • Coughing up blood

Control Plan - Early Identification

Risk factors for TB infection:
  • Being born in a country where TB is common
  • Having other lung or immune system disease
  • Being homeless
  • Having a substance abuse problem (alcohol or drugs)
  • Prison and or jail time
  • Exposure to others with TB infection

Control Plan - Early Identification

Any patient with TB symptoms must be:

  • Provided with a surgical-type mask.
  • Escorted to a private waiting room or when available, a negative pressure isolation room.
  • Receive immediate medical evaluation.
  • Instructed to cover his/her nose or mouth with a tissue when coughing or sneezing.

Control Plan - Airborne Isolation

Patients diagnosed with suspected TB are placed on Airborne Isolation. This requires:

  • A private patient room with negative pressure.
  • Patient wears a surgical-grade mask when out of the room.
  • All staff entering Airborne Isolation rooms will wear an N95 mask.
  • Isolation continues until patient is no longer infectious.

Control Plan - Employee Screening

  • Annual employee skin-test is mandatory.
  • Employees with a positive skin test will complete a symptoms review and have a chest x-ray if indicated.
  • Employee/Occupational Health will do follow-up skin-tests and treatment.

Transmission Based Precautions

In addition to Standard Precautions, further measures are taken when patients are suspected of having organisms that could be spread in ways other than in blood or body fluids

Airborne (Previously Respiratory)

  • Airborne Precaution are designed to prevent infection by germs that are spread by inhaling them after they are breathed out by an infected patient.
  • Diseases requiring Airborne Isolation are TB, chickenpox, and diphtheria.
  • Requirements: Private room with negative air pressure, N95 respirators.

Contact Precautions

  • Contact Precautions are designed to prevent transmission of organisms that are spread by contact with infected patients or contaminated items.
  • Examples of diseases requiring Contact Precautions are C. difficile, multiple resistant organisms, large draining wounds and lice or scabies.
  • Requirements: Private room when indicated, gloves when entering the room and gowns and masks for direct patient care.

Droplet

  • Droplet Precautions are used to prevent the spread of germs contained in large airborne droplets.
  • Examples of diseases requiring droplet precautions are pneumonia caused by resistant organisms, influenza, meningitis, or measles.
  • Specifications: Private room, gowns and gloves, surgical-grade masks and other PPE as indicated.

Combined Categories

  • Multiple isolation categories may be used for patients with infections that may be spread by both air and contact.
  • Examples of diseases: smallpox, viral hemorrhagic fevers, patients with TB infection plus resistant wound infections.
  • Specifications: Private room with negative air pressure, gowns, surgical grade mask, gloves.

Isolation Precautions

Always consult your facility’s Infection Control Manual for details.

Employee/Occupational Health

  • Know which childhood diseases you have had
  • Report all exposures immediately to your supervisor and go to employee health
  • Document all exposures through the ASIST
  • Participate in TB screening program
  • Complete all vaccinations as appropriate

HIV Testing

  • HIV testing requires written, informed consent
  • All testing results are confidential
  • You cannot be tested for HIV without your consent
  • Pre- and post-test counseling is provided by the HIV Program Coordinators

Hepatitis B Vaccination

  • May prevent infection if you are contaminated with blood or body fluids.
  • Is recommended for all employees that could be exposed to blood or body fluids.
  • Is available through Employee/Occupational Health Services to at risk employees free of charge.

Care of the Environment

  • You are responsible to ensure that your work spaces remain clear of clutter and debris.
  • Use only approved cleaners and disinfectants provided by the organization.
  • Food items must always be properly stored in sealed containers and refrigerated when and where appropriate.

Healthcare Worker Responsibilities

  • Infection Control is everyone’s responsibility.
  • Only you can reduce the spread of nosocomial (hospital acquired) infections to our patients and staff through managing your infection control practices.
  • Hand Hygiene: The single most important infection control measure.

You are the Infection Control Program in your healthcare agency!

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